Healthy Heart for Valentine's Day, pt. 2

Friday, February 15, 2013

So there I was in the ER room bed, all hooked up to monitors, and my silly phone alarm about to do a 5 minute cycle of snoozes and alarms. Ugh. That meant no more sleep or going through a rather awkward process of getting up enough to reach it, turn it off, and by the end of that process be awake enough I wasn't going to get back to sleep anyway.

Amazing timing, but someone came in to see me right at that moment. Financial services. Because I am uninsured, I had to sign something stating that (and that I took responsibility for paying) and was given a paper with what I need to bring back to help determine how payment can be handled. (There's a variety of things, like "Ability to Pay" determination as well as government stuff like MediCal and someone else later in the morning mentioned a Valley Health Plan.)

Anyway, I got her to hand me my phone so I could shut the alarm snooze off. Just as she finished, in came the first nurse. Vitals taken, she left and I realized I was thirsty and needed a restroom. But I'm all hooked up, so I have to wait for a nurse to come back. Then I remembered that I usually carry 2 of my 1-liter bottles to the gym -- could I possibly have a second? That very same effort to get up and get the phone that I'd managed to avoid was what I did to get my water ... and set off some alarm on my monitor. (I think my finger pulse thing got twisted and wasn't registering right, even though I got it straight before the nurse arrived.)

Good timing, though. A couple drinks of water and the restroom need was definitely making itself heard. She helped me get all unplugged, I got my shoes on (ER, so probably not wise to wander in sock feet), and off to the restroom I went. Came back feeling much better only to have the next nurse there with ... a urine sample bottle. A couple more drinks of my water, and off I toddled to see what I could get my bladder to produce.

Back I come and it's blood-drawing time again. I still had the one in my arm from early in the wee hours. However, the poor student nurse tasked with drawing the blood had trouble. The blood was just not flowing well. The regular nurse took over and, nope, wasn't the student nurses fault. It was in the vein. The line flushed properly. But the blood just was not willing to flow like it had before.

So, into my other arm (leaving the needle contraption in my left). First vein, same thing. Second (on the back of my hand of all places). I mention that other than the drinks of water I've just had, pointing at my liter bottle, I'd had nothing to eat or drink since some time before midnight. Finally they've gotten enough blood and they set up an IV -- my first ever on me -- which goes into that needle contraption in my left arm. Now I understand why they didn't remove it.

There's still no bed available just yet, but I do manage to ask a few questions and get the gist of things to be that even after I get moved there, I'm probably in for another night's stay. Things mostly settle after that with the IV getting fluids into me and my drinking getting even more fluids into me. But DANG am I getting hungry. All I've had to eat was afternoon snacks on Wednesday, then a chocolate milk I had for after my workout around 7 pm. The ER doesn't serve meals like they do up in the rooms. Which means 10 am is rolling around and other than water, I've had nothing. When the next nurse comes, I mention this and they scrounge up an orange juice and a milk.

** Oh, I'd forgotten one thing the ER doctor mentioned. While apologizing for the wait, he mentioned that the ER waiting room is usually anywhere from 4 to 8 hours of waiting for the ones that aren't critical - aka bleeding to death / dying. I made a crack about coming in a different day, but not really seeing that ANY day would be less busy. He said that this is one of the busiest hospitals. Most hospitals can celebrate clearing the ER on a few occasions. Here ... they celebrate the two or three days a year they clear the waiting room. (Now, I will add that there is major construction going on so they don't have all the beds they might usually or that they need. This is also the central government-run hospital to which they bring anyone without insurance, anyone from the city jail, etc. So it's not that they are slacking.) **

Finally, between then and 11 am, a bed opens up and I'm on my way upstairs to the main hospital area and an actual room. As I understood it at this point, there were two primary reasons I was being admitted.

One is that after the racing, my resting heart rate was LOW. As in upper 40s. I'm no athlete at that level and I already know mine was typically in the 58-62 range. (In fact, while in the ER, one of the nurses who responded to my HR monitor was tripping because the alarm that brought her was from my HR being too high, and she walks in to see a very low number. I told her it was "normal" for why I was in there. Haha!)

The other is that none of them could figure out why an otherwise perfectly healthy woman in her low 40s was experiencing this. I had so many nurses and doctors in and out, some asking the same questions, some asking new questions, blood drawn, vitals checked, heart monitored. (Oh, and there was a chest X-ray while down in ER - though I never thought to ask about that later, but I'm sure if it showed something, it would have been mentioned.)

In addition, there was the clot risk. With the atrial fibrillation, the top half of the heart isn't pumping right and blood can pool or collect because it's not being entirely pushed out of the section of the heart. That blood can clot, which can then get pushed out and continue to the brain - hence the stroke risk. I also got the impression it was likely I was going to be in the hospital at least another night. Super-UGH!

I finally managed to start making some phone calls from the phone by the bed. I had really bad timing for this. I knew my cell phone bill was due on Wednesday, but I wouldn't be ready to pay until Friday, but hadn't thought about how an ER visit might go and the impact. Result being no phone service once I was in the ER in a bed because there was no decent signal and no phone service by the time I got up to a room because I had no active service. Plus my phone battery was dying.

(I am going to start carrying one of my chargers in my backpack. Having no phone and no Kindle ... left me with 0 time-passing options besides TV which was truly unbearable. I think the only thing I watched for longer than 15 seconds was a news report of something near where I live and a snatch of Family Feud. The rest ... "ugh, new channel" which was useless with about 8 English, 3 Spanish, 1 Other, and 1 with blurry palm tree and wave images.)

Side effect of phone service being off was no way to contact my DDa or DS directly. Whoops. No way to check in with the OUTLAWS and say "I didn't croak". No way to go online and read up a little on atrial fibrillation. No way to go online and see if DDa's uncle, with whom they live, has a listed number. Etc. My DDa and DS are the only ones who would easily know where in my room to find my things, but they're the hardest to get hold of and don't have easy transportation. Others are awkward to ask.

I did finally call work and get them updated, called my father and let him know what was happening since I put him as the emergency contact for lack of a better (more easily contactable) person. Then I called my DDa's friend and left a message in her voice-mail to pass a message along to DDa.

Ahhhh, hospital food. I was in time for lunch. I was writing down each thing I was eating, then noticed the meal came with a paper that listed exactly what and how much was there. Nice! Lined out the stuff I passed on -- decaf coffee, sugar, creamer, cranberry juice cocktail -- and ate the rest. (I don't drink fruit juice things that aren't 100% fruit and cranberry is not on my list of juices I drink to begin with.)

For the next few hours it was a regular parade of nurses and doctors, checking things (a lot of stethoscopes ), asking questions, etc. One of the cardiologist team came and saw me mid-day and gave me an update, but the team head was supposed to come see me later and they were still trying to determine what possible causes there might be as well as get it more stable.

It had definitely improved by morning. When I was up super late in the ER waiting room and later in the bed, it had gotten frequent enough I'd say there was at least one episode or two every five to ten minutes. By the time I was up in the hospital room, it was much less frequent and was no longer dropping my HR as much.

About the time I got hold of one brother and was planning to have him assist with getting stuff from my room, the main cardiologist arrived (just a few minutes after 5 pm). He went over all the things they'd been looking for, all the risk factors that had been ruled out. There is no clear indication of a cause, unfortunately, so nothing obvious for me to avoid.

Other than the occasional racing (which is only a few beats in any one episode) aka the atrial fibrillation (AF), I have absolutely no other risk factors for stroke ... besides gender. There's no apparent cause. There's no heart damage evident at all, no other symptoms besides a single instant of light-headedness following jumping up from my desk and hurrying into the other room (something that isn't uncommon or limited to heart trouble). My blood pressure is completely in the normal range or a little low at points, never high.

The other arrhythmia is benign - both beats occur as they should, but it's just a slightly off tempo. (1-Normal, 2-Slightly early, 3-Normal). In fact, I may have had that one all my life and never really paid much attention to it. It wasn't until it was combined with the AF that it became more notable.

(And I think he's right about that. I remember vaguely long ago during one of my pregnancies being told I had something with how my heart beat that was slightly unusual but no cause for concern. In fact, when I remembered that, it seemed to have been part of why I figured the rapid beating was just another unusual but normal thing. I don't think Sunday was the very first episode. It's just when it started happening often enough that I didn't brush it off and forget about it. And, of course, there ARE actually completely normal situations that can cause a short bout of more rapid beating - stuff like what I was thinking of.)

He then discussed aspirin therapy with respect to reducing the risk of blood clots. My heart beats completely normal and healthy the rest of the time. In fact, the first EKG was almost 100% normal - and only a couple minor hitches (the benign arrhythmia) and the pulse jump the nurse had seen when I was first getting checked in gave them a clue to something more. The later EKGs all involved being connected long enough to pick up one or more episodes - several minutes of watching what otherwise looks mostly normal.

According to him, I don't really need blood thinners at this point - and those have side effects worse than aspirin might have that could be a real question of which is better and safer for me. Because I'm otherwise so low risk for stroke, we're not fighting an uphill battle against a bunch of problems. By that, he meant that I am not under heavy stress, I'm not obese (I did tell them about the weight loss and the time frames of the weights I've been), I don't smoke, I don't use any drugs, I drink rarely, I'm physically active and do 15+ minutes of cardio every day, 60 minutes three days of the week, I eat well. There's no history or heart problems in my family (I had to ask my father on that one. He has Type II Diabetes, but no heart issues. His father died of a fungal infection in the lungs. My mother died of a brain tumor. My grandmother lived to a little over 90 before dying, so even if it was heart that took her, age-related makes that normal. About the only slight maybe was my mother's father, but he did stuff like "polar bear" - swim in the frigid water in NY in the winter - smoke, and more that would have amplified his risk if his heart is what killed him.)

In fact, I asked a nurse later about my bloodwork and I'm completely normal and healthy by that. Potassium, Magnesium, and Calcium all perfectly in range, thyroid levels normal (something about the chemical from the brain to produce more thyroid stuff being elevated, but that being normal under the circumstances - and the thyroids responding normally to it), glucose totally fine (no diabetes or even pre-diabetes), etc. I'm separately scheduled for work on cholesterol numbers, but really don't expect any shockers there. I've tracked my cholesterol in what I eat on SP, and I really don't go to excesses. In fact, unless I have eggs, I pretty much never exceed the healthy range -- and eggs actually show in studies as increasing good cholesterol and decreasing bad, so the amount alone isn't the killer.

End result is that for now I'm to take aspirin (the 325mg version, preferably coated - which is what I later bought) for three months and evaluate. If I've gone that long without any obvious episodes, it is up to me whether to continue the regimen. If the episodes start occurring with frequency again, and more importantly if any other symptoms AT ALL show up, I'm to call in and get seen again.

I'm also ridiculously relieved to have OTC (over-the-counter) aspirin be the initial treatment. I do not like taking any drugs, not even pain relievers, unless it either 1) cures the cause of the symptom or 2) diminishes the symptom so the body can cure the cause of the symptom. Being stuck with something that cannot really be cured, just treated, had me rather leery of being stuck on some drug with side-effects almost worse than the symptom and doing nothing but trying to suppress the symptom. I can deal with aspirin easily - just adding it to my one-a-day and fish oil.

Now, the doctors didn't say this to me, but the other thing I plan to do is pay closer attention - not just to my heart but to what I do and eat in the couple days before changes occur. I would like to know if I did something different leading up to Sunday that prompted the entire situation. A single episode seems to not be too much concern because the quick return to normal gets the blood flowing correctly soon after. But the whole increasing number of episodes combined with the other arrhythmia combined and the resulting lower resting heart rate in between, that's not something I want to repeat again any time soon (ever). I won't be making excuses when it races - I'll be looking for possible connections and noting them. (As well as being aware of just how easy it is to see false connections.)

I'm glad I got a healthy heart for Valentine's Day 2013. Much better than having continued to ignore it and potentially missing my 44th birthday. Because I have a lot of living to do still. And now I don't feel like I'm saying "do as I say, not as I do" if I worry about someone else and suggest they see a doctor.

A real pain in the butt that's for sure. But I'm really glad it appears to be nothing you need to worry about. Someone else mentioned perimenopause, if you haven't had hormone levels checked it might be worth a look. I had heart episodes and basic panic attackes for almost 2 years before they figured out it was hormones. I was too young for that to be where their brains went. A little HRT took care of everything.

Very relieved for you that it seems all is well and Aspirin is the Rx.

I know you will be all over analyzing and collecting any data possible. I truly hope you never experience that again.

I truly love my HRM too. It really worked out that you had that to give you more evidence of the true need to get checked. I think you may have said before you can be stubborn, but in the end you are no doubt SMART!!

I'm so glad you're ok! I take daily aspirin because I'm at risk for stroke and have had a mild one already. I take 81mg twice a day otherwise I can't even get enough blood to check my blood sugar. Seriously when I have my blood work every three months they cringe when they see me coming. Most of the time - like 99% - they have to use a vein in the top of my left hand. None of my other veins will give up blood. Amazing how that happens.Keep tabs on what's going on so you can be better prepared for things. Take care.

Hey there....wow so sorry you had to go through all of that. Do you think any of this could be caused by perimenopause? I know menopause can do stuff to your heart. Hope the things you are doing well make this just a blip on the radar screen of your life and you won't have any more episodes. Hugs...Robin

So glad you are ok Blue!! It was awfully quiet around the campfire with out you around. Of course the dr.s could have put you on some bed rest so my pink team would have an advantage for the weekend...LOL!!